Citation Nr: 18154174
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 13-22 244A
DATE:	November 29, 2018
ORDER
Entitlement to service connection for dental problems for compensation and treatment purposes is denied.
Entitlement to service connection for lumbar spine degenerative disc disease (DDD), L5-S1 (claimed as low back pain) is denied.
Entitlement to service connection for bilateral hearing loss is denied.
Entitlement to service connection for tinnitus is denied.
Entitlement to service connection for traumatic arthritis of the bilateral hands and feet is denied.
Entitlement to service connection for hot flashes (claimed as ovary disease) is denied.
Entitlement to service connection for headaches is denied.
REMANDED
Entitlement to service connection for frostbite injury of the bilateral hands is remanded.
Entitlement to service connection for cold intolerance of the bilateral feet (claimed as frostbite injury) is remanded.
Entitlement to service connection for a skin rash (claimed as ant bites, lice/crabs in hair, dermatitis, eczema) is remanded.
FINDINGS OF FACT
1. The Veteran’s dental condition did not result in loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease.
2. Service connection under Class II or Class II(a) for dental treatment cannot be granted for the Veteran’s dental condition. 
3. The preponderance of the evidence is against finding that the Veteran has lumbar spine DDD, L5-S1 (claimed as low back pain) due to a disease or injury in service, to include a specific in-service event, injury, or disease. 
4. The Veteran did not exhibit bilateral hearing loss and tinnitus in service or within one year after discharge from service, and bilateral hearing loss and tinnitus are not otherwise shown to be associated with her active service.
5. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of traumatic arthritis of the bilateral hands and feet, disability manifested by hot flashes (claimed as ovary disease) or chronic headaches of service origin. 
CONCLUSIONS OF LAW
1. The criteria for service connection for a dental condition for compensation purposes have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.150.
2. The criteria for service connection for dental treatment purposes have not been met. 38 U.S.C. §§ 1131, 1712, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161.
3.  The criteria for service connection for lumbar spine DDD, L5-S1 (claimed as low back pain) are not met.  38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 
4. The criteria for service connection for bilateral hearing loss and tinnitus have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.
5. The criteria for service connection for traumatic arthritis of the bilateral hands and feet, hot flashes (claimed as ovary disease) and headaches are not met.  38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from February 1981 to February 1982. This matter comes before the Board on appeal from April 2011 and February 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. A Travel Board hearing was held in May 2018 before the undersigned Veterans Law Judge. 
As a preliminary matter, in the August 2013 substantive appeal (VA Form 9), the Veteran asserted that the March 2011 VA Audio examination was inadequate as the examiner stated that “due to poor reliability of responses and poor inter-test consistency, the audiometric results were not valid for VA rating purposes”. In light of the examiner’s assessment of the March 2011 audiogram, the Veteran was afforded a new examination. Here, the record indicates that the Veteran participated in a VA Hearing Loss and Tinnitus examination in January 2016, the results of which have been included in the claims file for review. The examination involved a review of the Veteran’s medical records; a thorough, in-person examination; and clinical findings based on the above. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).
Service Connection
Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby.  38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).
Generally, to establish entitlement to service connection, a veteran must show evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and an in-service injury or disease. All three elements must be proved. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).
Alternatively, under 38 C.F.R. § 3.303 (b), service connection may be established for certain chronic diseases listed under 38 C.F.R. § 3.309 (a) by either (1) the existence of such a chronic disease noted during service, or during an applicable presumption period under 38 C.F.R. § 3.307, and present manifestations of that same chronic disease; or (2) where the condition noted during service is not in fact shown to be chronic or where the diagnosis of chronicity can be legitimately questioned, then a showing of continuity of symptomatology after discharge is required to support the claim of service connection. 38 C.F.R. § 3.303 (b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).
Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, including arthritis and other organic diseases of the nervous system, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. 
Dental disorders are treated differently than other medical disorders in the VA benefits system. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161 (2016). Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150 (2016). These conditions include various problems of the maxilla, mandible, or temporomandibular articulation, loss of whole or part of the ramus, loss of the condyloid process or coronoid process, loss of the hard palate, or loss of teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease. See 38 C.F.R. § 4.150. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not considered disabling conditions, and may be considered service connected solely for establishing eligibility for VA outpatient dental treatment. See 38 C.F.R. § 3.381 (a) (2016).
For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels (dB) or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Tinnitus is a noise in the ears, such as ringing, buzzing, roaring, or clicking. See YT v. Brown, 9 Vet. App. 195, 196 (1996); See also Kelly v. Brown, 7 Vet. App. 471, 472.
When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.§ 5107 (b); 38 C.F.R. §3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).
1. Entitlement to service connection for dental problems
The Veteran contends that she has dental problems due to service. 
The Veteran’s October 1980 induction Report of Medical Examination did not show any diagnosed dental defects or disease. On the Report of Medical History, the Veteran endorsed “no” for “severe tooth or gum trouble”. Service treatment records (STRs) indicated that in February 1981, the Veteran sought treatment for a toothache. Dental treatment records dated September 1981 to November 1981 indicated that the Veteran was treated for tooth decay and received multiple fillings. There was no indication of dental disease, nor were any teeth extracted. The Veteran’s January 1982 separation Report of Medical Examination also did not indicate any diagnosed dental disease. On the Report of Medical History, the Veteran endorsed “no” for “severe tooth or gum trouble”. 
Post-service, in a November 2010 letter, the RO notified the Veteran that she should submit any dental treatment records as part of her service connection claim. The Veteran did not respond and no post-service dental treatment records are included in her claims file.  
In light of the above, the evidence does not reflect that the Veteran suffered any of the types of conditions that are described above as eligible for compensation, as there was no indication that she lost any teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease. Therefore, entitlement to service connection for a dental condition for compensation purposes is not warranted.
Despite the fact that service connection for dental problems is not warranted for compensation purposes, the Board must also consider whether the Veteran’s claimed loss of teeth, after service, can be service-connected for dental treatment purposes. 
As noted above, under 38 C.F.R. § 3.381, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are to be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. § 17.161. Specifically, they may be eligible under certain circumstances to receive Class II or Class II (a) dental treatment under § 17.161.
As a threshold matter, there is no material dispute that the Veteran is not eligible for dental treatment under Classes I, II (a)-(R), III, IV, V, or VI. Under Class I, she does not have a service-connected dental disability. Under Class II(a), she does not have a dental condition from combat wounds or service trauma. Under Classes II(b) and II(c), she was not homeless or a prisoner of war. Under Class II(R), she was not denied replacement of missing teeth with application made within one year of April 5, 1983. Under Class III, she does not have a dental condition, professionally determined to be aggravating a service-connected disability. Under Class IV, she does not have service-connected disabilities rated at 100 percent. Under Class V, she has not participated in VA’s Vocational Rehabilitation program and under Class VI, she was not scheduled for admission or otherwise receiving care and services under chapter 17 of 38 U.S.C. See 38 C.F.R. § 17.161. 
Under Class II, applicable in this appeal, the Veteran had a dental condition at the time of discharge, but STRs indicated that she underwent treatment for the condition during active duty. Notwithstanding, her discharge from service was honorable; she filed her service connection claim for dental treatment decades after separation and she has not undergone a VA dental examination.
Here, in a September 2010 Statement in Support of Claim, the Veteran asserted that she had “many problems with [her] teeth while in [the] military.” The Veteran asserted that she has had root canals, fillings, and has lost teeth. The Veteran stated that her teeth required extraction in 1990. The Veteran reiterated her contentions in several statements, including the March 2016 Notice of Disagreement (NOD). The Veteran contended that her dental problems began during service and that she sought treatment at Sick Call “many times”. During the May 2018 hearing, the Veteran testified that “prior to the military, [she] had perfect teeth”. The Veteran testified that she “had to go to the dentist to get them cleaned and . . . checked in the military.” The Veteran testified that “they started doing this, they started doing that and all of the sudden, I’ve got fillings here, fillings there, root canals there.” The Veteran testified that since separation she has “lost half the teeth in [her] mouth”. 
The Board notes that 38 C.F.R. § 17.161 provides for Class II dental treatment as reasonably necessary for the one-time correction of the type of dental condition that the Veteran claims and requires that the veteran have been discharged from service under conditions other than dishonorable for service of at least 180 days, that the veteran file an application for treatment within 180 days after discharge from service, and that a VA dental examination be completed within 6 months after discharge from service unless delayed through no fault of the veteran. 38 C.F.R. § 17.161 (b)(1)(i). In this case, the Veteran’s service connection claim for treatment of dental problems can be considered under the Class II criteria. However, although the Veteran was honorably discharged in February 1982, she did not file a claim for dental treatment until October 2010, which is beyond the one-year limit after discharge. Additionally, there is no evidence of a VA dental examination since separation. Therefore, the Board finds that service connection for dental treatment purposes is not warranted under Class II. See 38 C.F.R. § 17.161 (b)(2)(i)(A)-(C).
The Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, the claim is not in equipoise. See 38 U.S.C.§ 5107 (b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim must be denied.
2. Entitlement to service connection for lumbar spine DDD, L5-S1 (claimed as low back pain)
The Veteran contends that she has lumbar spine DDD because of her military service.
The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.
The Board concludes that, while the Veteran has a diagnosed lumbar spine condition, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.  38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d).
The Veteran’s October 1980 induction Report of Medical Examination indicated that the Veteran’s lumbar spine was normal. On the Report of Medical History, she endorsed “no” for “recurrent back pain”, “arthritis, bursitis, or rheumatism”, and “bone or other joint deformity”.  A review of the STRs indicated that the Veteran complained of and was treated for lumbar spine (low back) pain during her active duty service. A July 9, 1981 STR indicated that the Veteran complained of low back pain; her spine x-ray was normal. A July 15, 1981 STR indicated that she was diagnosed with upper lumbar pain, etiology unknown. On the following day, she continued to complain of low back pain. On July 18, 1981, she complained of low back pain and was diagnosed with paravertebral muscle strain; her spine x-ray was normal. Shortly thereafter on July 20, 1981, she complained of low back pain with onset the preceding two weeks. Again, her lumbar spine pain was assessed as being of unknown etiology.  
The Veteran’s January 1982 separation Report of Medical Examination indicated that the Veteran’s spine was normal. Again, the Veteran endorsed “no” for” “recurrent back pain”, “arthritis, bursitis, or rheumatism”, and “bone or other joint deformity”.  
In a September 2009 Statement in Support of Claim, and in several other statements, the Veteran asserted that she has experienced daily, constant low back pain since she “left the USA”. The Veteran contended that she injured her back in 1980 at Ft. Dix Military Base during basic training.  
The Veteran’s post-service medical records include an October 2010 x-ray, which showed disc space narrowing at L5-S1. A March 2011 VA examination report indicated that the Veteran was diagnosed with minimal lumbar spine DDD of L5-S1 consistent with natural aging; not caused by or related to service. In the examiner’s judgement, the Veteran’s lumbar spine disorder is consistent with natural aging and not caused by or related to military service. The examiner expounded on the fact that the Veteran’s STRs indicated that the Veteran was diagnosed with musculoskeletal low back pain that resolved in service. The examiner added that the Veteran’s July 1981 lumbar spine x-ray was normal and that the Veteran’s low back pain resolved as evidenced by no further complaints or follow-up for low back pain in service. The examiner emphasized that the Veteran’s January 1982 separation examination showed a normal spine and that the Veteran denied any low back pain. The examiner noted that the Veteran was diagnosed with minimal lumbar spine DDD at L5-S1, 29 years after separation; ultimately concluding that the Veteran’s condition is not caused by or related to her military service. 
In the March 2016 NOD, she indicated that she deserves a 40 percent rating for her lumbar spine DDD. She asserted that she experienced chronic pain whenever she moved her back in any direction. The Veteran asserted that she sought treatment at Sick Call for her lumbar spine DDD during service. 
During the May 2018 hearing, the Veteran testified that she “had to lift so much . . . before you could enter the service” and she “did do that.” The Veteran testified that her lumbar spine condition progressively worsened during basic training because she had to carry “all that gear”.  The Veteran testified that her military occupational specialty (MOS) of Motor Transport Operator (truck driver), required her to “pull maintenance on [her] vehicle . . . changing tires”, lift, roll and push tires and routinely “sitting in the seat of the truck for prolonged periods of time”.   
Based upon the foregoing evidence, the Board finds that service connection for lumbar spine DDD, L5-S1 (claimed as low back pain) is not warranted. In so finding, the Board observes that although the Veteran’s STRs show complaints of low back pain and diagnoses of upper lumbar pain, etiology unknown and para-vertebral muscle spasm, her in-service lumbar spine x-rays were normal. The Veteran was not diagnosed with lumbar spine DDD, L5-S1 or any chronic lumbar spine disorder during active duty. Additionally, the Veteran’s January 1982 separation Report of Medical Examination indicated that her lumbar spine was normal. On the Report of Medical History, she endorsed “no” for “recurrent back pain”, “arthritis, bursitis, or rheumatism”, and “bone or other joint deformity”.  
The Board also considers the normal October 2010 lumbar spine x-ray and the March 2011 VA medical opinion. The examiner noted the Veteran’s in-service medical history of low back pain and opined that the condition resolved during service. In the VA examiner’s judgment, the Veteran’s lumbar spine DDD, L5-S1 (claimed as low back pain) was diagnosed 29 years after the Veteran’s separation, is consistent with the natural aging process, and is not caused by or related to the Veteran’s service. 
It is well established that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).  As such, when reviewing medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another.  See Owens v. Brown, 7 Vet. App. 429, 433 (1995).  However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991).  The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert’s qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion.  Sklar v. Brown, 5 Vet. App. 140 (1993). As such, the March 2011 medical opinion is afforded significant probative value as the examiner reviewed the claims file, conducted an in-person examination, and provided an adequate basis for the medical conclusion. 
There is also no medical evidence or persuasive credible lay evidence that the Veteran’s claimed disorder manifested to a compensable degree within a year of her separation from service. Clinical evidence shows that the Veteran was diagnosed with lumbar spine DDD, L5-S1 decades after separation.  Furthermore, there is no credible persuasive evidence of continuity of symptomatology. As a result, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted.
While the Veteran believes her lumbar spine condition is related to service, the Board reiterates that the preponderance of the evidence weighs against finding that the Veteran’s lumbar spine condition occurred in service. The Board acknowledges that lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but are not competent to establish that which would require specialized knowledge or training, such as medical expertise.  Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Veteran contends that she injured her lumbar spine during basic training and while performing the duties of her MOS. Conversely, her July 1981 lumbar spine x-rays were normal. The Veteran’s January 1982 separation Report of Medical Examination indicates that the Veteran’s lumbar spine was normal. In addition, on the January 1982 Report of Medical History, the Veteran endorsed “no” for “recurrent back pain”, “arthritis, bursitis, or rheumatism”, and “bone or other joint deformity”. The Board finds the evidence contemporaneous to service more probative than assertions made years after the fact given its proximity to service.  As the clinical evidence does not indicate that the Veteran’s lumbar spine condition occurred during service or at separation, the clinical evidence is at variance with the Veteran’s current contentions that her lumbar spine condition was incurred in, or caused by service. Considering the Veteran’s lay assertions, the Veteran does not possess the medical expertise or specialized knowledge to provide a probative opinion regarding the nexus/relationship between her lumbar spine condition and military service given the particular facts of this case. 
For the foregoing reasons, the Board finds that service connection for lumbar spine DDD, L5-S1 (claimed as low back pain) must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, supra.
3. Entitlement to service connection for bilateral hearing loss and tinnitus
The Veteran contends that her bilateral sensorineural hearing loss and tinnitus are a result of her service. 
The existence of a present disability is established through the Veteran’s medical examination reports produced during the course of her appeal. The records contain diagnoses of bilateral sensorineural hearing loss and recurrent tinnitus, which establish that the Veteran has a bilateral hearing disability within VA standards.  See 38 C.F.R. § 3.385. 
Service treatment records revealed normal hearing at entrance and separation from service.  The October 1980 induction audiometry report reads, in decibels:  
			HERTZ		
	500	1000	2000	3000	4000
RIGHT	5	5	5	10	5
LEFT	20	15	15	20	10

The January 1982 separation audiometry report reads, in decibels:

			HERTZ		
	500	1000	2000	3000	4000
RIGHT	10	5	5	5	0
LEFT	5	0	5	5	5

As an initial matter, the Board notes that the Veteran’s STRs show normal bilateral hearing both at entrance and at separation from service and no complaints related to bilateral hearing loss. However, the Board points out that the absence of in-service evidence of hearing loss is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley at 159; see also Godfrey v. Derwinski, 2 Vet. App. 352 (1992).
As such, the remaining inquiry is whether the evidence demonstrates the incurrence of bilateral hearing loss in service or as a result of service. Upon review of the evidence, the Board concludes that the evidence of record is against a finding that the Veteran’s bilateral hearing loss and tinnitus is related to her service.
In an October 2010 Statement in Support of Claim, and other related statements, the Veteran contended that before service, her hearing was normal. The Veteran contended that she has bilateral hearing loss due to firing weapons during basic training. The Veteran asserted that she complained about her hearing loss “on the rifle range” during basic training.  
In March 2011, the Veteran underwent a VA Audio examination. The audiologist determined that due to the poor reliability of responses and the poor inter-test consistency, the audiometric results obtained were not valid for VA rating purposes. The Veteran endorsed recurrent tinnitus that began with a gradual onset “years ago”; the exact date is unknown. Nevertheless, the audiologist rendered the clinical assessment that the Veteran’s STRs indicated normal hearing bilaterally at separation, with some actual improvement noted in thresholds from the time of enlistment until separation.  The audiologist added that even though true hearing thresholds could not be determined during the examination, if any hearing loss or tinnitus is actually present, the hearing loss and tinnitus are not due to military noise exposure.  The audiologist’s opinion is based on the STRs, which are negative for hearing loss, hearing threshold shift, or complaint/diagnosis of tinnitus.
In January 2016, the Veteran was afforded a VA Hearing Loss and Tinnitus examination. The Veteran was diagnosed with bilateral sensorineural hearing loss and endorsed recurrent tinnitus. The audiometry report reads, in decibels:  
			HERTZ		
	500	1000	2000	3000	4000
RIGHT	25	40	45	45	50
LEFT	20	30	45	35	30

Speech discrimination scores were 88 percent, bilaterally. After a review of the Veteran’s claims file and an in-person examination, the audiologist rendered the clinical assessment that it is less likely as not that the Veteran’s bilateral hearing loss and tinnitus were incurred in or caused by her service. The audiologist noted the moderate probability of military noise exposure based on the Veteran’s MOS of Motor Transport Operator. The Veteran reported military noise exposure due to heavy trucks, diesel engines, and machinery and that she occasionally wore hearing protection. The Veteran denied civilian occupational/recreational noise exposure.  The audiologist noted the Veteran’s normal enlistment/separation audiograms. The audiologist referenced the unreliable, inconsistent results yielded by the March 2011 Audio examination as well. Ultimately, the audiologist opined that based on the conceded history of military noise exposure and the STRs, which are negative for hearing threshold shift/hearing loss, there is no objective evidence that the Veteran sustained noise injury during military service based on active duty audiograms. 
Regarding the Veteran’s tinnitus, the audiologist rendered the clinical assessment that based on the conceded history of military noise exposure, the Veteran’s reported date of onset of tinnitus, and the STRs, which are negative for complaint/diagnosis of tinnitus, hearing loss, or hearing threshold shift, there is no objective evidence that the Veteran sustained noise injury during military service based on active duty audiograms. 
In the March 2016 NOD, the Veteran asserted that she had continuous ringing in her ears. The Veteran asserted that she is entitled to a 20 percent rating for her bilateral hearing loss and a 20 percent rating for tinnitus. 
During the May 2018 hearing, the Veteran testified that she was required to wear ear plugs in service. According to the Veteran, “half [of the] time you couldn’t hear people. . . [s]ometimes you had to take one out”. The Veteran testified that she  “worked in the motor pool” and the “noise from the guys” made it “constantly noisy all the time”. Regarding tinnitus, the Veteran testified that she experienced “thumping in [her] ear”, “like a heartbeat”. The Veteran testified that her tinnitus “started maybe a year ago”. 
Upon review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding of service connection for bilateral hearing loss and tinnitus. In so finding, the Board considers the January 1982 separation audiogram which indicated that the Veteran had normal hearing and no reported tinnitus. Indeed, the January 1982 audiogram suggested that the Veteran’s hearing thresholds improved since enlistment. Moreover, the January 2016 VA medical opinion indicated that the Veteran’s bilateral hearing loss and tinnitus were not caused by or related to the Veteran’s service. Notably, the audiologist expounded on the fact that STRs did not indicate significant threshold shifts in the Veteran’s hearing acuity during active duty or at separation or that the Veteran complained of hearing loss or tinnitus during service. 
It is well established that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”  See Stefl, supra. The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert’s qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar, supra. As such, the Board affords significant probative value to the January 2016 VA medical opinion in that the audiologist reviewed the Veteran’s claims file, conducted an in-person examination, and provided an adequate explanation for her medical opinion. The medical opinion speaks to the issue at hand; whether the Veteran’s bilateral hearing loss and tinnitus are attributable to her service. 
Furthermore, the Board considers that the Veteran was diagnosed with bilateral sensorineural hearing loss and endorsed recurrent tinnitus, decades after separation. In sum, the Veteran was not diagnosed with bilateral hearing loss or tinnitus until more than 30 years after her separation from service.  The evidence indicates that the Veteran’s bilateral hearing loss and tinnitus did not manifest to a compensable degree within the one-year presumptive period after separation from service. Therefore, the Board finds that the evidence of record preponderates against a finding of service connection for bilateral hearing loss or tinnitus on a presumptive basis.  
The Board recognizes the Veteran’s assertion that her bilateral hearing loss and tinnitus are related to service-related acoustic trauma, specifically, encountered during basic training and in the course of performing her MOS duties. The Veteran is considered competent to report the observable manifestations of her claimed disability. In this regard, while the Veteran can competently report the onset and continuity of hearing loss symptoms, an actual diagnosis of bilateral sensorineural hearing loss requires objective testing to determine whether it is severe enough to be considered a disability for VA compensation purposes, and can have many causes. In any event, to the extent the Veteran may be competent to opine as to medical etiology, the Board finds that the Veteran’s lay assertions in the present case are outweighed by the medical evidence of record including the January 2016 VA medical opinion. The audiologist has the training, knowledge, and expertise on which she relied to form her opinion, and she provided a persuasive rationale for her clinical assessment. 
Thus, after reviewing the evidence of record, the Board finds there is no causal connection between the Veteran’s current bilateral hearing loss, tinnitus and her service. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection for bilateral hearing loss and tinnitus. The claim is therefore denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert. 
4. Entitlement to service connection for traumatic arthritis of the bilateral hands and feet, hot flashes and headaches
The Veteran contends that she has traumatic arthritis of the bilateral hands and feet, hot flashes and headaches because of her service.
The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.
The Board concludes that the Veteran does not have a current chronic diagnosis of traumatic arthritis of the bilateral hands and feet, hot flashes and headaches and has not had any of the conditions at any time during the pendency of the claim or recent to the filing of the claim.  38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d).
The Veteran’s STRs indicated that she did not complain of, was treated for, or diagnosed with traumatic arthritis of the bilateral hands and feet, hot flashes and headaches during service. Her October 1980 enlistment Report of Medical Examination indicated that her hands and feet were normal and that she did not have diagnosed hot flashes or headaches.  On the Report of Medical History, the Veteran endorsed “no” for “foot trouble”, “swollen or painful joints”, “arthritis, rheumatism or bursitis”, “bone, joint or other deformity”, “frequent or severe headache” or “head injury”.  The Veteran’s STRs indicated that the Veteran’s complaints, treatment and/or diagnoses included, but were not limited to, a cold injury to the feet, lice, low back pain, abdominal cramping, and a toothache. However, there was no indication of traumatic arthritis of the bilateral hands and feet, hot flashes and headaches during active duty. Her January 1982 separation Report of Medical Examination indicated that her hands and feet were normal and she did not have diagnosed hot flashes or headaches. On the Report of Medical history, she continued to endorse “no” for the same conditions listed on the enlistment Report of Medical History.
Post-service, the medical evidence of record does not suggest that the Veteran has diagnosed traumatic arthritis of the bilateral hands and feet, hot flashes and headaches. A March 2011 VA Cold Injury Protocol examination indicated that the Veteran did not have arthritis or joint stiffness, including limitation of motion in her bilateral hands and feet.
In several statements, the Veteran contended that she has had arthritis in her hands and feet since service. She also contended that she has daily hot flashes and headaches that began in service and persisted since her separation. In the May 2011 NOD and August 2013 VA Form 9, she asserted that she has traumatic arthritis of the hands and feet because of her exposure to “cold weather conditions” during service. In the same NOD, she contended that her headaches are due to “the stress of aggravation of the disease” during service. 
During the May 2018 hearing, the Veteran testified that during basic training “it was raining and cold” and she experienced pain in her feet. She testified that she “ended up on crutches for two weeks” because she could not walk. The Veteran testified that her feet “swell up and [she] can’t wear … shoes”, she cannot walk or run due to her bilateral feet disorder. The Veteran testified that she cannot “open [or grasp] anything” when she experiences pain in her hands.  She continued to associate her bilateral hand and feet pain with exposure to cold weather. Regarding her claimed hot flashes and headaches, the Veteran testified that she began experiencing hot flashes at age 21 or 22 during active duty, which continued after separation. When asked if a doctor diagnosed her with early menopause, the Veteran answered “yes”. The Veteran also testified that her headaches are a “family thing” and that she probably “inherited them”. 
Based on the foregoing evidence, the Board finds that service connection for traumatic arthritis of the bilateral hands and feet, hot flashes and headaches is not warranted. In so finding, the Board observes that the Veteran’s STRs indicate that the Veteran did not complain of, was treated for, or diagnosed with traumatic arthritis of the bilateral hands and feet, hot flashes and headaches during active duty. The Veteran’s January 1982 separation examination indicates that she was not diagnosed with traumatic arthritis of the bilateral hands and feet, hot flashes and headaches. After separation, the medical evidence of record does not indicate that the Veteran was diagnosed with any of the conditions. The March 2011 VA Cold Injury Protocol examination indicated that the Veteran did not have bilateral hands and feet arthritis or any functional impairment associated with arthritis or joint stiffness. 
As highlighted above, the most probative evidence fails to demonstrate that the Veteran has had traumatic arthritis of the bilateral hands and feet, hot flashes or chronic headaches at any time during the pendency of this appeal. The medical evidence of record is silent for current diagnoses of any of the conditions.  Indeed, menopause is the time that marks the end of a woman's menstrual cycle and is a natural biological process, and is not in and of itself a “disability.” There is no evidence that the Veteran’s symptoms of hot flashes were produced as the result of some type of “injury” incurred during service and are the product of some type of disability subject to service connection.  Also, there is no persuasive evidence that the Veteran suffers from chronic headaches that represent a continuing disease process of symptoms incurred in service as opposed to responses to separate and distinct events occurring post-service.  The Veteran has also not presented persuasive evidence showing that she has symptoms that result in any functional impairment sufficient to impact her earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that a “disability” under 38 U.S.C. § 1110 refers to functional impairment of earning capacity). 
Congress specifically limited entitlement to service connection for a disease or injury to cases where the disease or injury has resulted in a disability. In the absence of a proof of present disability there can be no claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992).  
While the Veteran believes she has a current diagnosis of traumatic arthritis of the bilateral hands and feet, disability manifested by hot flashes, and chronic headaches of service origin, she is not competent to provide a diagnosis in this case.  The issue is medically complex, as it requires specialized medical education.  Jandreau, surpa. Consequently, the Board gives more probative weight to the medical evidence of record.  
For the foregoing reasons, the Board finds that service connection for traumatic arthritis of the bilateral hands and feet, hot flashes and headaches must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, supra.
REASONS FOR REMAND
5. Entitlement to service connection for cold intolerance of the bilateral hands and feet (claimed as frostbite injury) is remanded.
The Veteran’s STRs indicated that she was diagnosed with cold weather injury after complaining of feet pain. A March 1981 STR indicated that she was diagnosed with “resolved cold injury”, after she complained of feet pain. In November 1981, she complained of cold intolerance and cold injury to her feet and was diagnosed with cold intolerance, etiology unknown. Her January 1982 separation Reports of Medical Examination and Medical History did not indicate that the Veteran had a diagnosis of cold injury to her feet at separation.
Post-service, a March 2011 VA Cold Injury Protocol examination indicated that the Veteran was diagnosed with cold intolerance of unknown etiology, claimed as frostbite injury to the feet. The Veteran endorsed numbness and joint pain in her fingers when exposed to cold weather. The examiner rendered the clinical assessment that the Veteran’s medical records and past/present clinical representation is not diagnostic of the claimed frostbite injury. The Board finds that another examination is needed to decide the appeal. 
6. Entitlement to service connection for a skin rash (claimed as ant bites, lice/crabs in hair, dermatitis, eczema) is remanded.
A June 1981 STR indicated that the Veteran was diagnosed with possible infestation after complaining about “itching all over”. She was later diagnosed with pediculosis pubis (lice). Her January 1982 separation Reports of Medical Examination and Medical History indicated that she had normal skin. A March 2011 VA examination indicated that her skin was normal and appeared warm, dry, with normal color and turgor. In the March 2016 NOD, the Veteran asserted that she has a skin rash that breaks-out monthly. Here, there is evidence of a current disability and evidence that the disability may be related to service, but the medical evidence is insufficient. Therefore, an examination is warranted under McLendon v. Nicholson, 20 Vet. App. 79 (2006). 
The matters are REMANDED for the following action:
1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any cold weather injury affecting the bilateral hands and feet.  The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including cold weather exposure during basic training in 1981.  The examiner is also asked to consider whether the Veteran’s claimed current symptoms and in-service symptoms are consistent with another type of disease, including Raynaud's phenomenon.
2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin disorder, including a recurring skin rash due to ant bites, lice/crabs in hair, dermatitis or eczema.  The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including her June 1981 complaint of “itching all over” and pediculosis pubis (lice) diagnosis.  


 
TANYA SMITH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Taylor, Associate Counsel 

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